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This section will explain the diferent tests that we run to help us determine what hormones you may be deficient in.

LIPID PROFILE -

What is a lipid profile?

The lipid profile is a group of tests that are often ordered together to determine risk of coronary heart disease. The tests that make up a lipid profile are tests that have been shown to be good indicators of whether someone is likely to have a heart attack or stroke caused by blockage of blood vessels (hardening of the arteries).

What tests are included in a lipid profile?

The lipid profile includes total cholesterol, HDL-cholesterol (often called good cholesterol), LDL-cholesterol (often called bad cholesterol), and triglycerides. Sometimes the report will include additional calculated values such as HDL/Cholesterol ratio or a risk score based on lipid profile results, age, sex, and other risk factors.

How is a lipid profile used?

The lipid profile is used to guide providers in deciding how a person at risk should be treated. The results of the lipid profile are considered along with other known risk factors of heart disease to develop a plan of treatment and follow-up.


CBC -

What is being tested?

The Complete Blood Count (CBC) test is an automated count of the cells in the blood. It provides information about the white blood cell (WBC), red blood cell (RBC), and platelet populations present. This information includes the number, type, size, shape, and some of the physical characteristics of the cells. In only a minute or two, the hematology instrument (the machine that is used to run the test) can measure thousands of RBCs, WBCs, and platelets and compare them against established normal ranges. Any abnormalities found are noted, and the clinical laboratory scientist (CLS) running the instrument then uses his or her expertise and experience to accept the automated findings and/or to target the sample for further analysis.

In most cases, the automated CBC is very accurate and the test is complete at this point. If, however, there are significant abnormalities in one or more of the cell populations, a blood smear test may be performed. In this test, a drop of blood is placed on a slide, smeared into a thin layer, allowed to dry, and then dyed with a special stain. A CLS then looks at the slide under the microscope and is able evaluate the cells present. Any additional information is added to that found by the automated count, and all of the findings are reported to the doctor. Blood consists of cells suspended in a liquid called plasma. These cells - the RBCs, WBCs, and platelets - are produced and mature primarily in the bone marrow. Under normal circumstances, they are released into the bloodstream as needed.

White Blood Cells (WBCs) -
There are five different types of WBCs that the body uses to fight infections or other causes of injury. These types - neutrophils, lymphocytes, basophils, eosinophils, and monocytes are present in relatively stable percentages that may temporarily shift higher or lower depending on what is going on in the body. For instance, with an infection, there may be a higher concentration of neutrophils (a “shift to the left). With allergies, there may be an increased number of eosinophils, and with leukemia, there may be a much higher percentage of a single type of cell, such as a lymphocyte. In this case, the cell may be present in large numbers, in a mature form and in a variety of immature forms. The CBC determines whether there are sufficient WBCs present to fight infection, notes when there are more than expected, and determines the percentages and numbers of each type.

Red Blood Cells (RBCs)
RBCs are reddish in color and shaped like a donut with a thinner section in the middle instead of a hole. They have hemoglobin inside them, a protein that transports oxygen throughout the body. The CBC determines whether there are sufficient RBCs present and whether the population of RBCs appears to be normal. RBCs are normally all the same size and shape; however, variations can occur with vitamin B12 and folate deficiencies, iron deficiency, and with a variety of other conditions. If there are insufficient normal RBCs present, the patient is said to have anemia and may have symptoms, such as fatigue and weakness. Much less frequently, there may be too many RBCs in the blood (erythrocytosis or polycythemia). In extreme cases, this can interfere with the flow of blood through the veins and arteries.

Platelets
Platelets are special cell fragments that play an important role in blood clotting. If a patient does not have enough platelets, he will be at an increased risk of excessive bleeding and bruising. The CBC measures the number and size of platelets present. With some conditions and in some people, there may be giant platelets or platelet clumps that are difficult for the hematology instrument to accurately measure. In this case, a blood smear test may be necessary.


TESTOSTERONE (FREE & TOTAL) -

What is being tested?

Testosterone is a steroid hormone androgen made by the testes in males. Its production is stimulated and controlled by luteinizing hormone (LH), which is manufactured in the pituitary gland. In males, testosterone stimulates development of secondary sex characteristics, including enlargement of the penis, growth of body hair and muscle, and a deepening voice. It is present in large amounts in males during puberty and in adult males to regulate the sex drive and maintain muscle mass. Testosterone is also produced by the adrenal glands in both males and females and, in small amounts, by the ovaries in females. In women, testosterone is converted to estradiol, the main sex hormone in females.


What are free and bioavailable testosterone?

Testosterone is present in the blood as "free" testosterone (2-3%) or bound testosterone. The latter may be bound to either albumin (a serum protein) or to a specific binding protein called Sex Steroid Binding Globulin (SSBG) or Sex Hormone Binding Globulin (SHBG). The binding of testosterone to albumin is not very tight and is easily reversed; so the term bioavailable testosterone (BAT) refers to the sum of free testosterone plus albumin-bound testosterone. Alternatively, it is the fraction of circulating testosterone that is not bound to SSBG. It is suggested that BAT represents the fraction of circulating testosterone that readily enters cells and better reflects the bioactivity of testosterone than does the simple measurement of serum total testosterone. Also, varying levels of SSBG can result in inaccurate measurements of BAT. Decreased SSBG levels can be seen in obesity, hypothyroidism, androgen use, and nephritic syndrome. Increased levels are seen in cirrhosis, hyperthyroidism, and estrogen use. In these situations, measurement of free testosterone may be more useful. However, technically, free testosterone is difficult to measure

DHEA-S -

What is being tested?

Dehydroepiandrosterone sulfate (DHEAS) is a sex hormone (androgen) created in men and to a lesser extent, women. It has a role to play in developing male secondary sexual characteristics at puberty and it can be metabolized by the body into more potent androgens, such as testosterone and androstenedione, or changed into the female hormone estrogen. DHEAS is produced primarily in the adrenal cortex - the outer portion of the adrenal gland - with much smaller amounts coming from the woman's ovaries and man's testes. DHEAS secretion is controlled by adrenocorticotropic hormone (ACTH) and other pituitary factors.

Since DHEAS is primarily produced by the adrenal glands, it is useful as a marker for adrenal function. Adrenal tumors, cancers, and hyperplasia (excess growth of hormone producing tissue) can lead to the overproduction of DHEAS. While elevated levels may not be noticed in adult men, they can lead to amenorrhea and visible symptoms of virilization (development of physical masculine characteristics) in women. These changes vary in severity and may include: a deeper voice, hirsutism - excess hair growth on face or body, male pattern baldness, muscularity, and acne. Excess levels of DHEAS in children can cause precocious puberty in boys; and ambiguous external genitalia, excess body hair, and abnormal menstrual periods in girls.


ESTROGEN -

What is being tested?

Estrogen is a group of hormones primarily responsible for the development of female sex organs and secondary sex characteristics. While estrogen is one of the major female sex hormones, small amounts are found in males. In women, follicular stimulating hormone (FSH; produced by the pituitary gland) stimulates cells (follicles) surrounding the eggs in the ovaries, causing them to produce estrogen. When the estrogen levels reach a certain level, the hypothalamus produces luteinizing hormone (LH), which eventually causes the release of the egg, beginning the preparation for fertilization.

There are three main estrogen fractions: estrone (E1), estradiol (E2), and estriol (E3).

Estrone (E1) is the major estrogen after menopause. It is derived from metabolites from the adrenal gland and is often made in adipose tissue (fat).
Estradiol (E2) is produced in women mainly in the ovary. In men, the testes and adrenalglands are the principal source of estradiol. Normal levels of estradiol provide for proper ovulation, conception, and pregnancy, in addition to promoting healthy bone structure and regulating cholesterol levels in females.
Estriol (E3) is the major estrogen in pregnancy, with relatively large amounts produced in the placenta (from precursors produced by the fetal adrenal glands and liver). Estriol levels start to rise in the eighth week of pregnancy and continue to rise until shortly before delivery. Serum estriol circulating in maternal blood is quickly cleared out of the body. Each measurement of estriol is a snapshot of what is happening with the placenta and fetus, but there is also natural daily variation in the estriol level.


THYROID -

What is being tested?

This test measures the amount of triiodothyronine, or T3, in the blood. T3 is one of two major hormones produced by the thyroid gland (the other hormone is called thyroxine, or T4). The thyroid gland is a small butterfly-shaped organ that lies flat across your windpipe. The hormones it produces control the rate at which the body uses energy. Their production is regulated by a feedback system. When blood levels of thyroid hormones decline, the hypothalamus (an organ in the brain) releases thyrotropin releasing hormone, which stimulates the pituitary (a tiny organ below the brain and behind the sinus cavities) to produce and release thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to produce and/or release more thyroid hormones. Most of the thyroid hormone produced is T4. This hormone is relatively inactive, but it is converted into the much more active T3 in the liver and other tissues.

If the thyroid gland produces excessive amounts of T4 and T3, then the patient may have symptoms associated with hyperthyroidism, such as nervousness, tremors of the hands, weight loss, insomnia, and puffiness around dry, irritated eyes. In some cases, the patient’s eyes cannot move normally and they may appear to be staring. In other cases, the patient’s eyes may appear to bulge.

If the thyroid gland produces insufficient amounts of thyroid hormones, then the patient may have symptoms associated with hypothyroidism and a slowed metabolism, such as weight gain, dry skin, fatigue, and constipation. Blood levels of hormones may be increased or decreased because of insufficient or excessive production by the thyroid gland, due to thyroid dysfunction, or due to insufficient or excessive TSH production related to pituitary dysfunction.

About 99.7% of the T3 found in the blood is attached to a protein (primarily thyroxine-binding globulin but also several other proteins) and the rest is free (unattached). Separate blood tests can be performed to measure either the total (both bound and unattached) or free (unattached) T3 hormone in the blood. produced by the thyroid gland (the other hormone is called thyroxine, or T4). The thyroid gland is a small butterfly-shaped organ that lies flat across your windpipe. The hormones it produces control the rate at which the body uses energy. Their production is regulated by a feedback system. When blood levels of thyroid hormones decline, the hypothalamus (an organ in the brain) releases thyrotropin releasing hormone, which stimulates the pituitary (a tiny organ below the brain and behind the sinus cavities) to produce and release thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to produce and/or release more thyroid hormones. Most of the thyroid hormone produced is T4. This hormone is relatively inactive, but it is converted into the much more active T3 in the liver and other tissues.
If the thyroid gland produces excessive amounts of T4 and T3, then the patient may have symptoms associated with hyperthyroidism, such as nervousness, tremors of the hands, weight loss, insomnia, and puffiness around dry, irritated eyes. In some cases, the patients eyes cannot move normally and they may appear to be staring. In other cases, the patients eyes may appear to bulge.

LUTEINIZING HORMONE (LH) -

What is being tested?

Luteinizing hormone (LH) is produced by the pituitary gland in the brain. Control of LH production is a complex system involving hormones produced by the gonads (ovaries or testes), the pituitary, and the hypothalamus, such as gonadotrophin-releasing hormone.

Womens menstrual cycles are divided into 2 phases, the follicular and luteal, by a mid-cycle surge of follicle-stimulating hormone (FSH) and LH. The high level of LH (and FSH) at mid-cycle triggers ovulation. LH also stimulates the ovaries to produce steroids, primarily estradiol. Estradiol and other steroids help the pituitary to regulate the production of LH. At the time of menopause, the ovaries stop functioning and LH levels rise.

In men, LH stimulates the Leydig cells in the testes to produce testosterone. LH levels are relatively constant in men after puberty. Testosterone provides negative feedback to the pituitary and the hypothalamus, helping to regulate the amount of LH secreted.

In infants and children, LH levels rise shortly after birth and then fall to very low levels (by 6 months in boys and 1-2 years in girls). At about 6-8 years, levels again rise with the beginning of puberty and the development of secondary sexual characteristics.


FOLLICLE-STIMULATING HORMONE (FSH) -

What is being tested?

Follicle-stimulating hormone (FSH) is made by the pituitary gland in the brain. Control of FSH production is a complex system involving hormones produced by the gonads (ovaries or testes), the pituitary, and the hypothalamus, such as gonadotropin-releasing hormone.

In women, FSH stimulates the growth and maturation of ovarian follicles (eggs) during the follicular phase of the menstrual cycle. This cycle is divided into two phases, the follicular and the luteal, by a mid-cycle surge of FSH and luteinizing hormone (LH). Ovulation occurs shortly after this mid-cycle surge of hormones. During the follicular phase, FSH initiates the production of estradiol by the follicle, and the two hormones work together in the further development of the egg follicle. During the luteal phase, FSH stimulates the production of progesterone. Both estradiol and progesterone help the pituitary control the amount of FSH produced. FSH also facilitates the ability of the ovary to respond to LH. At the time of menopause, the ovaries stop functioning and FSH levels rise.

In men, FSH stimulates the testes to produce mature sperm and also promotes the production of androgen binding proteins. FSH levels are relatively constant in men after puberty.

In infants and children, FSH levels rise shortly after birth and then fall to very low levels (by 6 months in boys and 1-2 years in girls). At about 6-8 years, levels again rise with the beginning of puberty and the development of secondary sexual characteristics.


HOMOCYSTEINE -

What is being tested?

This test determines the level of homocysteine in the blood or urine. Homocysteine is a sulfur-containing amino acid that is normally present in very small amounts in all cells of the body. Homocysteine is a product of methionine metabolism. Methionine is one of the eleven essential amino acids - amino acids that must be derived from the diet since the body cannot produce them. In healthy cells, homocysteine is quickly converted to other products. Vitamins B6, B12, and folate are necessary to metabolize homocysteine. Patients who are deficient in these vitamins may have increased levels of homocysteine.
Recent studies have suggested that people who have elevated homocysteine levels have a much greater risk of heart attack or stroke than those with average levels. Increased concentrations of homocysteine have been associated with an increased tendency to form inappropriate blood clots. When this happens it can lead to heart attack, strokes, and blood vessel blockages in any part of the body.
Homocysteine can be greatly increased in the blood and urine of patients with a rare inherited condition called homocystinuria. This disorder is caused by an alteration in one of several different genes. The affected person has a dysfunctional enzyme that does not allow the normal breakdown of methionine. Because of this, homocysteine and methionine begin to build up in the persons body. A baby with this condition will appear normal at birth but within a few years will begin to develop signs such as a dislocated lens in the eye, a long slender build, long thin fingers, skeletal abnormalities, osteoporosis, and a greatly increased risk of thromboembolism (inappropriate clotting in their arteries and veins), and of atherosclerosis (fatty plaques) that can lead to premature cardiovascular disease. The buildup may also cause progressive mental retardation, behavioral disorders, and seizures

FASTING INSULIN -

What is being tested?

Insulin is a hormone that is produced and stored in the beta cells of the pancreas. Insulin is vital for the transportation and storage of glucose at the cellular level; it helps regulate blood glucose levels and has a role in carbohydrate and lipid metabolism. When blood glucose levels rise after a meal, insulin is released to allow glucose to move into tissue cells, especially muscle and adipose (fat) cells, where is it is used for energy production. Insulin then prompts the liver to either store the remaining excess blood glucose as glycogen (for short-term energy storage) and/or to use it to produce fatty acids. These are eventually used by fat cells (adipose tissue) to synthesize triglycerides to form the basis of a longer term, more concentrated form of energy storage. Humans and many animals must have insulin on a daily basis to survive. Without insulin, glucose cannot reach most of the body’s cells. Without glucose, the cells starve, and glucose blood levels rise to dangerous levels. Eventually, very high glucose levels lead to a life-threatening condition called a diabetic coma.
People with type 1 diabetes produce very little insulin and must supplement with insulin injections several times a day. People with type 2 diabetes usually can produce insulin but may need oral medications that increase the sensitivity of their body’s cells to insulin (the cells may become resistant over time and/or with obesity) or that stimulate their body to produce more insulin. Type 2 diabetics also may need to supplement with insulin injections to achieve normal glucose levels.

Insulin and glucose levels must be in balance. Hyperinsulinemia, an excess amount of insulin most often seen with insulinomas (insulin-producing tumors) or with an excess amount of administered insulin, can be dangerous. It causes hypoglycemia, low blood glucose levels, which can lead to sweating, palpitations, hunger, confusion, visual problems, and seizures. Since the brain is totally dependent on blood glucose as an energy source, glucose deprivation due to hyperinsulinemia can lead fairly quickly to insulin shock and death.


CRP (C-REACTIVE PROTEIN) -

What is being tested?

C-reactive protein (CRP) is a substance made by the liver and secreted into the bloodstream. Its concentration increases within a few hours after the start of an infection, making it especially valuable for monitoring infections. Its rise in the blood often precedes pain, fever, or other clinical indicators. The level of CRP can jump a thousand-fold in response to inflammation. It drops relatively quickly as soon as the inflammation passes, making it a valuable test to monitor effectiveness of treatment.


SERUM CORTISOL -

What is being tested?

Cortisol is a hormone produced by the adrenal glands (small organs on top of each kidney). Production and secretion of cortisol is stimulated by ACTH (adrenocorticotropic hormone), a hormone produced by the pituitary gland – a tiny organ located inside the head below the brain. Cortisol has a range of roles in the body. It helps break down protein, glucose, and lipids, maintain blood pressure, and regulate the immune system. Heat, cold, infection, trauma, stress, exercise, obesity, and debilitating disease can influence cortisol concentrations. The hormone is secreted in a daily pattern, rising in the early morning, peaking around 8 a.m., and declining in the evening. This pattern, which is sometimes called the “diurnal variation” or “circadian rhythm,” changes if you work irregular shifts (such as the night shift) and sleep at different times of the day.
Inadequate amounts of cortisol can cause nonspecific symptoms such as weight loss, muscle weakness, fatigue, low blood pressure, and abdominal pain. Sometimes decreased production combined with a stressor can cause an adrenal crisis that requires immediate medical attention.

Too much cortisol can cause increased blood pressure, high blood sugar, obesity, fragile skin, purple streaks on the abdomen, muscle weakness, and osteoporosis. Women may have irregular menstrual periods and increased facial hair; children may have delayed development and a short stature.


PSA -

What is being tested?

This test measures the amount of prostate specific antigen (PSA) in the blood. It was developed as a tumor marker to screen for and to monitor prostate cancer. It is a good tool, but not a perfect one. Elevated levels of PSA are associated with prostate cancer, but they may also be seen with prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH). Mild to moderately increased concentrations of PSA may be seen in those of African American heritage, and levels tend to increase in all men as they age.
PSA is a protein produced primarily by cells in the prostate, a small gland that encircles the urethra in males and produces a fluid that makes up part of semen. Most of the PSA that the prostate produces is released into this fluid, but small amounts of it are also released into the bloodstream. PSA exists in two forms in the blood: free (not bound) and complexed (bound to a protein). The most frequently measured PSA test is the total PSA, which measures the sum of the free PSA and the cPSA (PSA complexed with other plasma proteins). When a doctor orders a “PSA test,” he is referring to a total PSA.
Free PSA and cPSA tests can also be ordered individually. The tests that measure them were developed to better differentiate between cancer-related and non-cancer-related PSA increases. Both of the tests operate on the principle that patients with prostate cancer frequently have altered ratios of the two forms of PSA - decreased amounts of free PSA and increased amounts of PSA.

PSA is not diagnostic of cancer. The gold standard for identifying prostate cancer is still the prostate biopsy, collecting small samples of prostate tissue and identifying abnormal cells under the microscope. The total PSA test and digital rectal exam (DRE) are used together to help determine the need for a prostate biopsy. The goal of testing is to minimize unnecessary biopsies and to detect clinically significant prostate cancer while it is still confined to the prostate. The term clinically significant is important because while prostate cancer becomes relatively common in men as they age, many of the cases are very slow-growing. Doctors must try to both detect prostate cancer and to differentiate between slow-growing cases and prostate cancers that may grow aggressively and metastasize (spread to other parts of the body). Over-diagnosing and over-treatment are issues with which doctors are currently grappling. In some cases, the treatment can be worse than the cancer, with the potential for causing significant side effects, such as impotence and incontinence. The PSA test and DRE can detect most cases of prostate cancer, but they cannot, in general, predict the course of a patient’s disease.


PROGESTERONE -

What is being tested?

This test measures the level of progesterone in the blood. Progesterone is a steroid hormone whose main role is to help prepare a woman’s body for pregnancy; it works in conjunction with several other female hormones.

On a monthly basis, the hormone estrogen causes the endometrium (the lining of the uterus) to grow and replenish itself, while a surge in lutenizing hormone (LH) leads to the release of an egg from one of two ovaries. A corpus luteum (small yellow cellular mass) then forms in the ovary at the site where the egg was released and begins to produce progesterone. This progesterone (supplemented by small amounts produced by the adrenal glands) stops endometrial growth and readies the uterus for the possible implantation of a fertilized egg.

If fertilization does not occur, the corpus luteum degenerates, progesterone levels drop, and menstrual bleeding begins. If a fertilized egg is implanted in the uterus, the corpus luteum continues to produce progesterone. After several weeks, the placenta replaces the corpus luteum as the main source of progesterone, creating relatively large amounts of the hormone throughout the rest of a normal pregnancy.


DHT -

PLAC -

What is being tested?

By measuring levels of Lp-PLA2 (lipoprotein-associated phospholipase A2), a cardiovascular-specific inflammatory enzyme implicated in the formation of vulnerable, rupture-prone plaques, the PLAC test provides important information specific to your patient's risk of an ischemic stroke or coronary event.

The PLAC test is a blood test that was cleared by the FDA for the quantitative determination of Lp-PLA2 in human plasma to be used in conjunction with clinical evaluation and patient risk assessment as an aid in predicting risk for coronary heart disease, and ischemic stroke associated with atherosclerosis.

Predictive. Powerful. Specific.
Predictive

Levels of Lp-PLA2 have been found to be significantly higher in cases of ischemic stroke, while LDL-C levels typically have not
Lp-PLA2 can help identify stroke-prone hypertensive patients
Lp-PLA2 is a strong risk factor for stroke and CHD, statistically independent of traditional risk factors as well as markers of systemic inflammation, such as CRP and fibrinogen
The PLAC test provides you with a clearer picture to help determine the right risk reduction strategy that can prevent your patients from suffering an ischemic stroke or heart attack
Powerful

Individuals with elevated Lp-PLA2 levels double an individual's risk of stroke or coronary event, independent of traditional risk factors
Individuals with the highest levels of Lp-PLA2 and systolic blood pressure had a sixfold higher risk of suffering an ischemic stroke
Specific

Lp-PLA2 is a cardiovascular-specific inflammatory enzyme implicated in the formation of vulnerable, rupture-prone plaque
The PLAC test reports consistent and reliable values that do not typically fluctuate during acute systemic inflammation
Because Lp-PLA2 is not typically elevated by other concomitant inflammatory conditions, it can easily be used in all necessary patients to gather accurate cardiovascular risk information

The PLAC test is a high-complexity test as categorized under CLIA 88 and must be run in laboratories that are CLIA-certified as highly complex.

Ischemic Stroke and CHD can be prevented if you focus on the risk

Ischemic stroke and coronary heart disease (CHD) have numerous things in common. Both conditions occur from a reduction or stoppage of blood flow, and they both have many, but not all, of the same risk factors. Proactive strategies that reduce the risk can help minimize an individual's risk for having a heart attack or stroke.

The important thing to remember is that stroke and CHD can be prevented.

The PLAC® test is a simple blood test that is performed at Griffin Medical Group. The PLAC test helps better determine your risk for coronary heart disease, and ischemic stroke associated with atherosclerosis.

Understanding Stroke
Stroke is a leading cause of serious long-term disability in the United States.

Understanding the risk factors and risk management strategies is an important first step in stroke prevention. Learn how the PLAC test can play an important role in helping you understand if you are at risk for ischemic stroke.

Understanding Heart Disease
Coronary heart disease is the leading cause of death in the United States.

Traditional risk factors such as elevated cholesterol, high blood pressure, smoking and obesity are not always present in patients with coronary heart disease.

Risk factor identification remains one of the most important approaches to preventing coronary heart disease. Understanding the risk management options available to you is vital. Find out how the PLAC test can aid in predicting your risk for coronary heart disease.

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